Provider Demographics
NPI:1487873550
Name:STITT, GRANT MAURICE (LCSW)
Entity type:Individual
Prefix:MR
First Name:GRANT
Middle Name:MAURICE
Last Name:STITT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 UNIVERSITY PL
Mailing Address - Street 2:SUITE 402
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4528
Mailing Address - Country:US
Mailing Address - Phone:646-230-8166
Mailing Address - Fax:
Practice Address - Street 1:99 UNIVERSITY PL
Practice Address - Street 2:SUITE 402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4528
Practice Address - Country:US
Practice Address - Phone:646-230-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRPO46313-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP575079OtherOXFORD HEALTH PROVIDER
NYRPO46313-1OtherLICENSE NUMBER